B cell depletion therapy based on rituximab in patients with rheumatoid arthritis (RA) was pioneered at UCLH/UCL in 1998. The objective of this study was to evaluate long-term persistence of rituximab and identify factors associated with discontinuation of treatment.Retrospective review of medical records from all rituximab-treated RA patients followed up in a dedicated clinic (1998-2020). Data collected included gender, disease duration, previous DMARDs, autoantibody status, age and concomitant therapy at first cycle, length of follow-up, number of cycles. Drug survival and factors associated with drug discontinuation were analysed using Kaplan-Meier survival curves, logrank test and Cox regression analysis.A total of 404 patients were included. Median disease duration and age at time of first rituximab cycle were 10 and 57 years, respectively. Median total follow-up was 55 months and median number of cycles five. 93.1% of patients were seropositive. 31.2% of patients stopped RTX, with the largest reason for discontinuing being primary inefficacy (42.1%). Comparison of Kaplan-Meier curves showed that rituximab drug survival was lower in seronegative patients and in patients who had previously failed at least one biologic DMARD (bDMARD). Cox regression analysis revealed that RTX discontinuation was associated with a greater number of previous bDMARDs.Many patients with RA achieve good control of their disease with repeated cycles of rituximab treatment. The most common reasons for treatment discontinuation were either primary or secondary inefficacy. Patients who were seronegative and who had previously failed other bDMARDs were more at risk of drug discontinuation.
Caitlin Norris-Grey, Geraldine Cambridge, Samantha Moore, Venkat Reddy, Maria Leandro